Mid Term 2 study Flashcards
What 3 things does intervention planning involve
iterative rather than linear process
Documentation of the sequence of decisions made during development
includes stakeholders and end users
Involve iterative rather then linear process
- loop refine and adjust components before moving forward due to challenges suprises etc
Documentation of the sequence of decisions made during development
early stage considerations like who is on the team and who does what
time and resource availibility - how much time do we have, room for testing and costs
external demands like who he funders are policy makers and restrictions of design
considered alternatives - what other options did we consider, what did we include or exclude, and why
Include stakeholders and end users
- target groups practitioners who deliver the intervention and policymakers that control the adoption and implementation of it
What does intervention planning include and what is it
- multidisciplinary meaning not just what works in theory but what works in the real world to meet real world needs and designs - common framework is the bartholemew approach most widly used as it framed that process as a series of tasks and is intuitive
what is one framwork used to made interventions - BCW
- an approach to intervention creation
19 framworks in 1 model - built around 3 layers
center is the source of the behavior includes what drives the behavior - capability - physical psycological ability to change
– opportunity - whether the enviroment supports or hunders change
- capability - physical psycological ability to change
- motivation - willingness or readiness to change
- next layer is the intervention functions which is like how do we actually do this
- then the outer layer is the policy categories like the guidlines palnning regulation etc
this is very time consuming because of the policy categories
Intervention mapping - 10 tasks of behavior change intervention design development implementation and evaluation
- every task requires deep thinking every decision you make has multiple parts not everyone comes to effective outcome
good interventions dont just happen they evolve - everything that follows occurs in a spiral up and down
1. Define the problme
2, clarify how behavior change can resolve the problem
3. identify the targeted people behavior and levels
4. understand the underlying mechanisms
5, designs the intervention
6, pilot the intervention
7.. refine the intervention
8,. implement the intervention
9. evaluate the efficacy of the intervention
10. evaluate the effectiveness of the intervention
Intervention mapping 10 tasks first 3
- understand the behaviour and identify change targets
1. understand and defien the problem uncluding assessing the needs of target groups
2. clarify how behavior change can ameliorate or resolve the problem
3. identify which groups of people neeeds to change which behavior or behavior patterns and at what level ie individual organizational governmental or multiple - these three can be accomplished through the use of needs analysis
Needs assessment
- a systematic process for determining the discrepancy between current conditions and desired conditions
- done at the begginign of project to ensure that an intervention is needed before spending time and resources
- determines who needs the intervention how great the need is and how to best meet it
- the responses to this needs assessment will help you to consider carefullt the behavior pattern that is to be changed as well as the charecteristics lifestyles and the culture of those the intervention is designed to help
- a robust needs assessment will include infomation from multiple soureces ie experts in the field empiriacal evidence experience from takeholders and the target auidence
- needs assessment are often delivered at multiple time points for ongoing interative designes
Needs assessment question examples
- what is the behavior you are trying to change
who is thr group you are trying to affect
when and where is the undesirable behavior occuring - not a finite list and you need to
- knowlesge and awareness of the behauors
motivation and psychological factors of the behaviors
resources and practical support of the behavior - social influences and norms
enviromental and structural factors
how can we ask needs assessment question
- binary choice
likert sclae
multiple choise - open ended question
- interveiw questions
- these go from least to most amount of richness in end data
Action planning - needs assessment next step
- needs assesssment is done to gather the information required to bring about change beneficial to the health of a specific population
- but it does not result in change or clarification of the objectives
what is the key to action planning - needs assessment
- understand how it related to the rest of your intervention planning procedures
- results of a needs assessment shoul dbe frame di nkey lessons learned ie what are the biggest takeaways how do we think interventions should look like and what is the best way to go about it and result in action steps focus on how to implement these lessons in to th next steps of action planing
- example - most people dont exercise because they lack the time to the intervention should focus on short exercise
example of an action plan chart
- what is the need for the intervention
- what is the cause of the behavior - may be more than one
- what are the consequences for not having the intervention and the need not met
- what is the difficulty to corrent the behavior for all the above
- how crtical is it to correct
- what is the action you are taking to correct it
Intervetion mapping - ten tasks what is the 4th point
understand behavior antecedents, that is, the contexts cues and underlying mechanisms that maintain the targeted behavior patterns for each targeted group
- mechanisms must be considered on a behaior by behavior and target group to target group basis and you must have the right theroy for it to work
- interventionists should search for relevent evidence like published articles to identify mechanisms of behavior regulation
- based on this knowledge base, interventionists will also need to select the empirically driven theories of behaviour change that are relevant to the articulated mechanics -
Intervention mapping - 4th point - how do we choose the right theory
- achnowledgement to it out of your head that there is a right theory in the first place, there are multiple that can probably work but the key is designing an intervention is to be thoughtful listen to the people do the research and though to different theories out there you will probably make a good choice
- consider the evidence based you can blend 2 or more theories as well use also focus efforts on modifiable factors that have relationship to the behavior
Intervention mapping - ten taks point 5
- design interventions and intervention components that can alter some or all of these behavioral antecedents and regulatory mechanisms
- in this step interventionists will need to translate their chosed theory of beahvior change into behavior change techniques that guide the intervention
this stage should be co-created with intended users and implementers to maximize the ADOPTION , FIDELITY OF IMPLEMENTATION, AND SUSTAINABILITY - should also include the involvement of everyone
Behavior change techniques - modifiable factors
- the active ingridients that are responsible for bringing about change in interventions
- things like knowledge, awareness of the issues , shifting narratives and norms and self efficacy
- some factors are more modifiabnle than others
- tools now exists which capiture manu os not close to all of the factors that can effectivly be targeted in behavior change programs including the BCTT which is the behavior change technique taxonomy
- across all the theoies we learned there are some key behavior techniques that can be targetted
Behavior change techniques - goal setting tech
- how can you help someone increse tehir commitment ability self efficacy feedback or resources to achive a particular goal
- behavior
problem solving
- behavior
- outcome
- action planning
- review behaviour goals
Behavior change techniques - self effiicacy
- PMT and social cog theory
- how can you affect personal accomplishment vicariosus expierience verbal persurastion by others and or perceptions of min emotional arousal
- verbal pursuasion about capability
mental reheresal of successful performance - focus on past success
Behavior change techniques Salience of consequence technique
- Social cog theory and theoyr of planned behavior
- how can you emphasize the consequences of performing the behavior
- infor about health consequences
salience of consequences
infor about social and envirmoental conseqince - monitoring of emotional consequence anticipated regret
- information about emoitonal conseuqnence
Behavior change techniques - appraisal techniqes -
- common sense model health belif model and PMT model
- what can you do to increse threat or coping appraisals
- social support unspecified
- social support practical
- social support emotional
- instruction on how to perform a behavior
- infomration about antecedents
- reattribution
Intervention mapping - ten tasks - poitn 5 - what is it important for interventionists to articulate
- the purpose for which they are intervening ie what is the primary outcome
- the intervention strategy that they are using - what behavior change theory
- the reson they have slected that strategy - what mechanism of ction is targetted
- the conditions under which they are pursuing these goals, i.e. for whom, when, and or where is this intervention being tested
What is the final outcome of task 4 and 5 of intervention mapping
- program logic model
- a precise map of what an intervention is designed to change and how it will and will not work
- program logic models are meant to focus on the big ideas and are depicted on one page
- program logic models read like a series of if then statements arranged in a temporal sequence
- there are many ways to go about creating a program logic model but often include inpits activities outcomes and short term long term outcomes other possible componets include the audience situation assimptions and external factors
common program logic model componets
- inputs - the resouces invested into a program or incentive ie the funding staff time matrial supplies etc
-activities - activities or interventions that will be carried out as part of the program liek workships announcements what is it that you are doing - outcomes - products that are produced from program activities or interventions outputs can be viewed as quentifying activities and provide numeric values or attributing percentages like the percent of people in a certain group that is attending
- outcomes - the changes expected to result from the program ,outcome range from short term to long term and are associated with changed in knowledge awareness behavior and skills like iexpected increse in knowledge or decrese in people reporting STDs or low PA or BMI
Additional program logic model components
- audience - who is the program targetting
- istuation - the situational context that led to the creation of the program
- assumptions - underlying theories and beliefs about the program and its contect which can influence how the program is implemented, transparency around assumptions makes explicit that beliefs that underlie chosen actions
- external factors - factors that make the program but are beyond the control of the program planners and overseers , factors may be positive or negative and are liekly to influence program success
program logic models
- situations to inputs - to activities to audience to outputs to outcomes - havd to have certain assumptions and external factors
so program logic model…
- precision in all stages is key to some questions
intervention strategy - what is the duration intensity delivery mode setting what evidence exitss in existing literature to indicate relationship between the sum of specific strategies and observed outcomes
- mechanism of action
- why this mechniams over another
how is it distrunct from other potential targets
will multiple mechniams work to affect behavior independely or jointly
how will you emeasue the change in these mechanisms over time
- why this mechniams over another
- outcome
- what is the desired frequency of behavior
does the behavior in question need to be changed or maintained - does the changed behavior need to be iniated incresed reduced or eliminated
will the maintained behavior contrite to require active deliberation or will it become more automatic over time
Intro to intervention planning Step 6
_ pilot or pretest intervention prototypes to discovery whether they are acceptable feasible and affordable
- intervention tat is unattractive, unaffordable or unsuitable in context will not be adopted or if they are adopted is likely to be ineffective because it is not delivered as designed
- pilot the feasibility study in advance of a future main study is helpful to investigate areas of uncertainty about the later main study, so we need to think about future possible issues
what are major questions to resolve at step 6
- is the intervention acceptable ie are the end users stakeholders satisfied with the program
is it feasible ie is the program suitable for its intended use - is it affordable - is it implemented with the intended budget
Step 6 - Feasibility study
- peices of research done before a main study
- purpose is to ask whether something can be done should we proceed with it and if so how
- the primary outcome of it is to identify barriers to implemntation
Assesses the following - Recruitment practicality - can we recruit enough participants within our target population
- STudy procedures - can participants complete the study steps ie attending sessions and filling out forms
- resource availibility - are necessary personnel facilities and funcing availible
- participant commitment - will participants stay engaed or is dropout likely
- data collection - are the measurement tools practical and reliable in this setting
-ethical and institutional barriers are there any administrative or regulatory issues that need to be addressed - intervention timing and delivery- can we deliver the program as planned or do adjustments need to be made
so
refine and devlop intervention with those who will implement and experience it to optimize fidelity of implementation and effectiveness w key stakeholders
implement the intervention and identify and minimize embedding problems - often, interventions don’t work because they don’t fit into real-world situations
How is step 6 accomplished - pilot study
- small study for helping to design a further main study sometimes referred to as proof of concept
-the purpose of a pilot study is similar to a feasibility study but does so by conducting a main study or part of a main study on a smaller scale - the primary outcome of a pilot study is to test the impact of an intervention oncomes, so what we are doing is a preliminary outctually working on proof of concept doing it with a small group, so we aren’t putting it all in one basket
Step 6 What does a pilot study assess adnd also internal vs external pilots
- initial effectiveness - are there early signs that the intervention is working as expected
- participant experience - do participants find the intervention engaging helpful and relevant
- retention and complicance - do participants drop out or are they consistently engaging
- measurent validity - to pre and post measures detect meaningful changes
-unexpected outcomes - are there any suprising postives or negative effects - comparision to control group = if applicable how do early results compare to a non intervention group
External pilot
- A rehearsal of the main studfy wher ethe outcome data are not includied as part of the main trial outcome data set
Internal pilot
- when the pilot phame forms the first part of the trail and the outcome data generated may contribute to the final analysis you might choose this one becuase of time money maybe you only have a grnat that lasts 3 montsh need to pre specify
FOR BOTH PRE, SPECIFY IF THE STUDY IS INTERNAL OR EXTERNAL
What is the difference between pilot and feasbillity
- not super clear
- feasibility is a broad ategory that includes any early research done to see if an intervention is practical or diable - helps answer questions of if we are doing it the right way and are we improving and can we do this
- pilot is more specific type of feasbility study that follows the same sturcture as a full blown intevention includes control groups randomisations etc but the goal is to give initial findings like are we on the right track can we do this in the way we planned to
All pilot studies are feasibility studies, but not all feasibility studies are pilot studies
Step 7
- refine and devlop the intervention with those who will implement and experience it to optimize fidelity of implemnation and effectiveness
- successful implementation not only relies on effectiveness but also reaching the target population through adoption fidelity and delivery, how compatible the intevrvention is to the organization or communiy
- optimize the intervention performance in relation to certain criteria
Step 7 identification of what needs to be refined can be achives with the REAIM framework - what is it
Reach - the absolute number proportion and representativeness of individuals who are willoing to partake in a given intitive intervention or program
Efficacy - the impact of an intervention on important indiviudal outcomes - impact of intervention on outcomes including potential negative effects and broader stuff like QOL and economic outcomes
adoption - the absolute. number proportion and representativeness of settings and intervention agents - people who deliver the program who are willing to initiate a program - many different levels ie staff school system people etc
Implementation - the intervention agents fidelity - the degree of axactness with which someonthing is reproduced to an interventions key functions or components - the consistency of delivery of something not just me or you but lots of people trained to delier the program
maintenance- the extent to which a program or policy becomes institutionalises or part of the routine organizational practises and policies also applies at indiviudal level - long term effects on what comes after program is completes - depends on project to project basis
Step 8
implemet the intervention and identify and minimise embedding problems
- go time
- throughout this intervention, it is important to log thoughts and any feedback you may receive or observe however, once you are in this stage, it is not the time tos as this would greatly harm the intervention fidelity, don’ make any changet make changes in the middle of step 8
Evaluate the intervention Steps 9 and 10 - Step 9
Evaluate efficacy by investigating where the intervention shows evidence of changing targed antecedents and behaviors
Efficacy - the performance of an intervention under ideal and controlled circumstances
may only include perfect candidates, highly standardised highly controlled so has results with high internal validity not very real world applicable different diets weights feelings etc
Step 10
- evaluate effectiveness by testing the intervention in new contexts and scaling up to target groups of populations
effectiveness - the performance of an intervention under real world condtions
- how it would work in real wold changing situations ie more variables to consider and external validity
How do we design an intervention
- Experiemntal - charecterised by the random allocation of participants to different conditions control of all variables with the exeption of th eone being tested and the ability of the design to be replicated
Quasi - experieental - similar to an experimental deisgn but lacks randomisation - looks at things taht peole cant control ie blonde hair set and aintain gold better then brunette you cant control hair color and tehrefore cant fully randomise as its not ethical/impossible to
Nonexperimental - studies where an experimenter simply either describes a group or examines relationships between preexisting groups - no causal relationships, not randomly assigned independent variable not manipulated by the experimenter, descriptive in nature
Types of experimental designs - Individually randomised control trails
- a study design that randomly assigns participants into an experiemtal group or a control group as a means to compare one or more treatment/programs
Pros - the gold standard test of intervention efficacy minimise bias and standardises the intervention
cons - costly in terms of time and money doesnt always reflect real life
Types of experimental designs - individually randomised control trails cluster randomised trails
- more to the real world
participants are randomised as groups rather than individuals
pros -
Reduces the risk of intervention contamination and minimises bias in estimates of effect size
cons
higher risk of selection bias ie failue to ensure that an experiemtal group is representative of the target population and confounding factors
Types of experimental deisgns - quasi - Interrupted time series design
- examines the effect of an intervention by analysing trends in repeated measurement before and after the intervention is inroduced allowing researchers to assess whether changes in the outcome variable are due to the intervention rather then natural fluctuations over time
pros
particularly useful for poulations with small sample sizes every individual received the intervention highly logistical and feasible
cons
difficulty controlling for pre existing trends potential for confoudning factors
Types of expirimental designs - quasi - natural experiments
- evaluate interventions that are not developed by a researcher where a population is split into exposed and unexposed groups because of a natural occurance ie policy changes geographical differences enviroemntal events socioeconomic shifts and health crisis
pros
allow reseachers to examine cause and effect relationships when an RTC woul dnot be feasible or ethical
Cons
potential for confounding factors, something might have kind of occurred naturally, but you could be mistaking something found as a clear result for something else that might have been happening at the same time, too
Types of non experimental deisgns qualitative
- non numerical data ie interveiew focus groups from 1-2 to 2-8 people observations that explore experiences perceptions and meaning in depth often to understand complex social nd psycholoogical phenomena
- qualitative methods are often used alongside quantitative methods in experimental and quadi experimental designs ie mixed methods
pros
rich depth of understanding (probing questions_ explored unexpected or nuaned effects gives a voice to participants
cons
resource intensive limited generalizabuility as its their own lived expirence subject to research bia difficult to compare develop ask transcribe etc very time consuming and quantify
Intervention mapping ten tasks - evaluate intervention - what do we evaluate
- the target behavior itself
- its not black and white theres lots factors the go onto it external like your watch dying or internal
Time - how long the behavior should occur for
level of change - how is it being measured is it easy to categorise do we want complete removal or just a decrese
frequency - how frequent should behavior occur
Situation - what exact situation should the behavior occur ie some people have gym memberships others dont think about access account for eeverythign weather and how do we individualise it
theoretically based mechanisms of change
How do we evaluate 4 steps
- have a good theoretical understanding of the intervention as articulated in your program logic model
- choose suitable outcomes
- identfy measures that match your outcomes of interest and are appropriate for your study design - consider whether practical objective measures ie anthropometric measures observations of behavior exists or if subjective measures like perceptions of self efficacy self resported smoking rates will need to be used
- implement these measures before and after and sometimes during pending your study design the provision of the intervention
Evaluate the intervention - qhat should it do
- assess process of implementation ie acceptability sustainability and fidelity
- evaluation should also assess aspects of the implentation context ie the setting variation in target populations that may influence intervention effectiveness
- final element of task 10 is to conduct longer term evaluation of interventions at the population level
even after an intervention has been proven efficasious and effective doesnt mean that it will be used in the real world
Interventions 2 - knowledge translation - knowledge to action gap
- the gap between the evidence that is produced by researchers and the evidence used in practise
knowledge translation - knowledge to action framework
- a conceptual framework intended to help those concerned with knowledge translation deliver sustainable evidence based interventions
- originally developed in 2006 by dr ian graham and inclues the process of :
Knowledge of action framework - Knowledge translation def
- exchange synthesis and ethically sound application of knowledge interactions between researcher and user
- collaborate systemic review assesment identification aggregatoina and practical application of high quality disability and rehab research by key stakeholders
KNowledge to action framework - knowledge transfer
- systematic approach to capture collect and share tacit knowledge to become explicit knowledge
KNowledge to action framwork- knowledge exchange
- collaborate problem solving between researchers and decision makers mutual learning through planning producing disseminating and applyiing existing or new research n decision making
Knowledge to action framework - research utilization
- process in which specific research based knowledge ie science is implemented in practise
Knowledge to action framework - implementation
- execution of the adoption desciion that is th einnovation or the research put into practise
Knowledge to action framework - dissemination
- spreading of knowledge or research, such as is done in scientific journals and at scientific conferences
Knowledge to action framework - diffusion
- the process by which an innovation is communicated through certain channels over time among members of a social system
Knowledge action framework - Diagram
Funnel creation (middle peice) called knowledge creation and is made up of
- knowledge inquiry - ask questions or database
- knowledge synthesis - big takeaways
- knowledge tools/products - like google scholar - this then leads into the outer ring
Called the action cycle
First section down from knowledge creation
- identify problme, determine know-do gap
- identify review and select knowledge
Knowledge action framwork action cycle outer ring
going from the first section left
Adapt knowledge to local context = setting where the change occurs and people who are affected by the change
Assess barriers facilitators to knowledge use - impede intervention or imporve liklihood of success
select tailor implement interventions - enhance uptake implementation and sustainability of intervention
monitor knowledge use - is it actively being used colelct data see how well it is being implemented
Evaluate outcomes - impact or if any difference has occured past vs present etc
Sustain knowledge use - maintain practise chage after the intervention
for both the inner and outer circle they dont need to be compeleted in a certain order but they all need to be completed at a certain point
Two - eyes seeing knowledge circle
- action cycle closely mirrors the teo eyed one
- think of knowledge as water how it moves through things
How does knowledge come to us - through rain snow and knowledge from elders young observations etc
how is knowledge stored
- natural like lakes ice snow or like collect through speakign with others lab etc
How is knowledge translated and shared
- change clouds to rain snow ice or knowledge from trucks streams lakes etc
How is knowledge used
- carry nutrients supports
- support levels of people
Lots of types of knowledge that must be respected by world which is built into indigenous knowledge traditions and not as seen much in others where in like RCT where there is a gold standard
Discussing KT documentary takeaway pts
- make sure its releveant research with consumer collaboration
enaging the knowledge users ask the right questions accelerating impct of research what does the user want medium is what you are using to utilize to translate the information
KT -
- most popular term used to describe the knowledge to action process in canda
- the process of turning knowledge (research) into action and encompassing the process of both knowledge creation and knowledge application
- the primary purpose of KT is to address the gap between what is known from research and the implementation of this knowledge by key stakeholders with the intention of improving systems and outcomes
Knowledge translation.- knowledge users
- individuals who are likely to be able to use the knowledge gained through reseach
- examples of knowledge users include practitioners policy makers decision makers community members patient groups or the media
- when identifying knowledge users researchers should do so keeping in mind the projects thesis, research questions, overall goals and expected results and should ask themselves
Who stands to benefit from this research
which audiences will be involved when and how
how will the audience benefit from being incolved and how will the researcher benefit from their involvement - should be a symbiotic relationship that benefits both researchers and users
what is the best way to communicate with these audiences - tailor messages for them depending on who you are talking to
4 Fundamental elements of KT
- synthesis - integrating findings from differnt studies ie systematic review
- dissemination - identifying an audience and tailoring the sharing of knowledge to them ie tools and creation ie summaries to stakeholders
- exchange - enaging between researchers and knowledge users ie repositories learning including planning producing and applying existing or new research
- ethically sound application of knowledge - putting knowledge into practice, i.e. policy changes
When to implement KT
- end of project KT - common not as useful
- shared knowledge gained during project
presented after project is complete ie published journals conference presenattions - doe snot follow the action cycle framwork very closley - Integrated KT - more impactful
- active engagement between researchers and knowledge users through entire process
- Kt is ongoing through project
includes needs assessments feasbility assessments
What does successful KT involve
- getting knowledge users involved early
- thinking about all potential stakeholders
- customizing the message
- helping knowledge users overcome usage barriers - even if you do something perfectly, there are still some obstacles, so how do you overcome it
KT examples - what would finidngs look like
- journal articles
guidelines
short film
narrative
fictional narrative
interpretive dance
comic book
poetic transcription
ethnodrama - need to tailor it to the individual group you want to target
Individual differences
- the variations and distinctions between people in terms of their charectistics behaviors or abilities which wnen obseved as a whole mak up the piences of an individuals peronality
- these are often stable characteristics that don’t vary muchual over an individ lifespan (traits over states)
Trait vs state
trait - long term and enduring charecteristics of an individual that shows thorugh their thoughts feelings and actions somethign that connects them al ie someone thats always in a tight state of mind even when there are other things going on
- state - a temporary way of being that an individual experiences for a short period of time, i.e. anxiety, but changes when you sit down to take an exam
Explanatory style theory
broader work on learned helplesssness and optimism
explains how people interpret and explain cause of events in their lives particularly in reponse to success and failure
features of optimists vs pessimists a stable personality trait and an environment for personality interaction
What are the dimensions of explanatory style theory
internal - external - Its me vs its someone else
Stable - unstable - going to last forever vs its temporary
Global vs specific - going to affect everything that happens to me vs its only going to influence this
those with a pessimistic explanatory style explain bad events as internal stable and global and good events as external unstable and specific which limits ability to build confidence and motibvation
People with an optimistic explanatory style explain bad and good events in the opposite way
Health research explanatory style found what
- pessimistic style predicts
Risk of phsycial illness
higher risk of heart attack
incresed mortablity - optimistic style predicts
lower stress level and a stronger immune function
greater use of health protective behaviors - these are due to suggestions that there may be behavioral biological and social pathways that explain the relationship abobve
The five factor theory of personality
-most popular appraoch to personality
classify the amount that an indiviudal embodies the following traits
- schoring high on the top 4 means better health happiness and wellness while scoring high on the last one means lower wellbeing and higher negative emotions - OCEAN
- openess, conscientiousness, extraversion, agreeableness, Neurotisim
Five factor Theory - Openess
- reflexts a persons curiosity creativity and willingness to try new things
- high openness - imaginative open to new ideas, quick to understand things
- low openness 0 prefers routine and familiarity more practical and conventional
Five-factor theory of personality - Conscientiousness
- refers to a persons level of organization responsibility and dependability - make bed every day high awareness of others thoughs and feelings
- high - detail oriented disciplined reliable and goal focused
- low - more impulsive, less organized, more likely to procrastinate
Five factor theory - extraversion
- describes a personas level of socialbility assertiveness and energy in social situations
- high - outoging talkative seeks out social interactions
- low - introversion, reserved, prefers solitude or smaller social settings
Five factor theory - agreeableness
- measures a persons tendancy to be cooperative compassionate and trusting towards others
- High - warm, empathetic willing to compromise
- low - more competitive skeptical and sometimes less cooperative
- interested in other people sympatheise about feelings and has a soft heart
Five factor theory - Neurotisicm
- reflects a persons emotional stability and tendancy to experience negative emotions
- high - more prone to anxiety mood swings and smotional instability
- low - calm emotionally resilient, less reactive to stress
- easily stressed out and easily disturbed
Five factor theory - takeaways
- Personality changes in individuals with Alzheimer’s disease are marked by significant decreases in conscientiousness
- Higher conscientiousness is associated with lower obesity risk
- Neurotisism - is the trait most strongly (tho negatively) related to health conditions ie chronic illness or physical injury
- higher level of openess to experience and neurotisim are each significantly associated with incresed risk of anu lifetime cigarette use
- extraversion is the strongest predictor of PA out of all the traits
- high agreeable adulthood types reported less alcoholism and depression, fewer arrests, and more career stability than low agreeable types understand society
The dark triad
- theory of maladaptive personality traits
- considered dark becuase they manipulate, self seve and potiantially harmsul to others
- the three compoents are psychopathy, machiavellianism and narcissism
- all 3 share charectistiscs such as lack of empathy, interperosnal hostility (cold and distrustful) and interpersonal offensiveness (lying disregard needs and feeelings of others)
- these traits have significnat overlay with one another but have been shown to be distinct enought to warrent seperate examination
- these traits can be socially and emotionally harmful but are not necessarily pathological
- low agreeableness is the largest predictor of high dark triad
- high neuroticism and low conscientiousness are also correlated with it
- high score on 1 usually means high score on others too
The dark traid - Psychopathy - what is it and what has health research found
- lack of empathy, remorse and an overall tendency to disregard social norms and rules, often leading to antisocial behaviours
-higher rates of disease substance use and injuries
- associated with poor health behaviors due to impulsivity and a live fast approach meaning a shorter lifespan and high risk taking
The dark triad - machiavellianism - What is it and what has health research found
- involves a manipulative and exploitative aporoach to ones personal interactions often prioritising personal gain over ethical considerations
-higher rates of disease substance use and injuries but less storngly then psychopathy
- also linked to long-term strategizing and self-monitoring, which may increase stress and harm health over time
The dark triad - narcissism - what is it and what has health research found
- charecterised by an inflated sense of self importance a need for excessive attention and admiration and a lack of empathy
- predicts both positive and negative health outcomes
- positive - more likely to exercise eat breakfast and attend medical checkups motivated be self image
- negative - linked to higher rates of migraines and harmful behaviors liek excessive sun exposure due to impulsivity and preference for immediate rewards
Equality
- each individual or group of people is given the same resources or opportunities
Equity
- recognizes that each person has different circumstances and allocates the exact research and opportunities needed to reach an equal outcome
- determined by which conditions people are born in work in age etc
Privillage
- a special advantage or opportunity that is available only to certain and taken away at any time
Right
- an inherent, irrevocable entitlement held by all citizens or all human beings from the moment of birth
The right to health - WHO
- all who member states have ratified at least one international human rights treaty that includes the right to the highest attainable standard of health
-Canada health act is canadas federal legislation for publically funded health care insurance - the act sets out the primary objective of canadian health care policyy which is to protect promote and restore the psychocal and mental well being of residents of canada and to facilitate resonable access to health services without financial or other barriers - verbal commitments implied commitments and treaty texts have also promised rights to health and medical services to the Indigenous people of Turtle Island these promises have been rarely recognized and or implemented by the Canadian federal government
WHO - health
- one of the fundamental rights of every human being
-fundamental to the attainment of peace and security and is dependent on the fullest cooperation of individuals and their nations
The right to health - United nations high commisioner for human rights - what do aspects of the right to health include
- inclusive right
- contains freedoms
- containes entitlements
- health services goods and facilities must be provided to all without any discrimnation
- all services, goods, and facilities must be available, accessible, acceptable and of good quality
The right to health - united nations high commissioner - Inclusive right
- not only access to health care and hospitals but to a wide range of factors that can help us lead a healthy life, including
- safe drinking water and adequate sanitation
- healthy working and enviromental conditions
- health related education and information
- gender equity
- safe food
- adequate nutition and housing
The right to health - UN - Freedoms
- health contained freedoms
- these freedoms refer to the right to being free from non-consensual medical treatment, i.e. medical experiments, research torture or other cruel, inhumane, or degrading treatment or punishment
The right to health - UN - ENtitlement
- a system of health protection providng equality of opportunity for everyone
- the right to prevention, treatment and control disease
- access to essential medicine
- maternal child and reproductive health
- equal and timely access to basic health services
- provision of health related education and information
- participation of the population in health-related decision-making
The right to health - UN - Health services goods and facilities must be provided to all without any discrimination
- non discrimination is a key principle in human rights
Prejudice - A favouring or dislike oof something without good reason
Discrimination - prejudicial treatment of different categories of people, things, or ideas
The right to health - UN - All services and facilities must be available, accessible, acceptable, and of good quality
Available - Must be present in sufficient quantity
Accessible - Physically accesible to all including vulnerable groups - Financially affordable and non discriminatory - right to access health information ie seek receive and impart it in an accesible formate while maintaining data privacy
Acceptable - must respect medical ethics and be gender sensitive and culturally appropriate
Good quality - Requires trained professionals approved drugs, proper equipment sanitation and safe drinking water
Discrimination
- any distinction, exclusion, or restriction made on the basis offect of impairing or nullifying the enjoyment of human rights linked to the marginalization of groups and is at the route of inequalities we experience and make groups more vulnerable to things like stress and ill various grounds which has an efhealth
Discrimination - Racism
- think of is as a house build of of things - how does it affect health
First off we have the cultural rasicm which is the foundation of the house - deeply embedded belif systems steryotypes in society like media protraying negative perceptions steryotypes of indigenous and creates enviroment for racial prejudice and bias to grow and is the hardest to build support
then we have structural institutional rasim - how societal institutions ie legal system education housing and healthcare sysematically disadvantage racial minories - ie residential segregation ie underfunding healthcare systems reducing access to quality schools healthcre facilities and economic opportunity - long term conseuqnces of poor education employment and poor health outcomes
Lastly, we have individual racism - directly lived experiences of being treated unfairly because of race, i.e. applying for job bias treatment in healthcare settings - triggers health responses similar to other traumatic events - linked to higher rates of hypertension, depression, anxiety, and reduced use of healthcare systems because of distress
How does discrimination affect individual health - four outcomes
- biological dysregulation - higher levels lead to higher bp inflammation weakened immunity
- worsened mental health - depression anxiety
- maladaptive health behaviors - unhelathy coping behaviors like smoking and drinking
- reduces trust in healthcare system - avoid seeking healp
- need to challenge stereotypes, improving policies, health, and equity, not just individual behaviour rooted in broader systems understand this key to more equitable health outcomes
Social support video summary
most important study of our current time was a adult development study based on human wellbeing with 700 participants of men through 85 years of trcking to see what leads to a happy healthy life
- found that the key to happiness is others -
- Good relationships keep us happy health and is best to depend on for joy and the quality of the relationship was the storngest preductor of physical health and emotional well being and eld to incresed mental health and longer life expectancy
Social capital
- the value dereived from positive connections between people communities institutions and nations
- often operationalised with three dimensions
- social ties
- level of trust that charecterise these ties
- resources or benefits that are gained /transferred by these social ties
- measurment is difficult
Social support
- resources and help we received from our soical etworks ie family friends colleauge and sometimes pets
- perceived support - the belief that help is availible if one needs it ie the confidence that your friends family will have your back when things get tough
- received support - the actual help that one receives
- ## perceives is the strongest linked to good mental and physical health
What other perspectives can social support be seen in
Structural support - size and frequency of social ties and is how connected someone is in social networks - understood under a couple dimensions aswell
- Quantity of relationships
- Frequency of interactions - how often are you engaged
- network diversity.- from different sectors or your life ie friends from work schoold sports family
- types of relationships - how close you are ie family friends best friends etc
- structural support increases opportunities for functional but doesn’ t guarantee that the support is meaningful or helpful
Functional support - quality and type of support provided rather than how many and is more important than structural 3 dimensions of this
- Emotional support - the availability of esteem trust concern and listening from another, comfort belief that they are respected loved etc
-informational support - the availability of advice or infomration - eeds support to understand their world or adjust to change ie what would you do in my shoes - advice
- Instrumental support - help with concrete needs, i.e. time, money, labour, goods, and services
How does social support effect health
- 2 key models
- buffering model - suggests that suport is more beneficial during high stress situations by reducing the psychological and physiological impact of stress ie lose job have someone to talk to leads to better health effects
- alternative the main effect model - suggests that support improved health directly by increseing positive emotions and promoting health related behaviors
-so act as a safety net if you are stressed or boost well-being even when life is relatively stress-free
social support and health - when considering health research around social support has found that
- Individuals who have more social support have greater longevity - ie in elder populations socially supported individuals reported experiencing fewer diseases 1.5 times less likely to have a eheart attack
- timing of and person providing the social support matters - hospital patients paried with a post op patient before they went into surgery experinced less anxeity than those paired with another pre op patient
-social support interventions have significnat impacts on the recovery rates of clinical populations - in separate interventions conducted with woemn with breast cancer and individuals with melanoma those that were assigned to suppose group style programes expericesd enhanced survival rates over control groups
- Social support helps students - students with stronger support systems experience less stress and better mental health
message framing
- refers to presenting the same information in different ways with the goal of influencing how people intrepret and respond to it
- in health spaces messages are often arguments that invvoke the consequence or wards of an action ie if then then statement
- these messages are shown in the public health campaigns that are advertised through video, print media, social media warning labels, etc
Prospect theory
- preducts that people process information differently deopending on whether it relates to losses (costs) or gains (benefits
decision makers organize based on potential gains vs potential loss
Loss framed messages
- focus on the negative outcomes of doing or not doing the behavior ie eating high fat equals cancer
- loss framed messages are more effective for encouraging early detection behaviors ie self examinations HIV testing
- perceived risk - more responsive to messages that focus on los or harm like I am going to test for this and figure this out
Gained framed messages
- Focuses on the positive outcomes of doing or not doing the behavior like eating low fat means you are healthy
- most effective for encouraging prevention behaviors ie using sunscreen or buckling your seatbelt - low risk maintain health rather than discovery problems
- Also, cessation behaviours like smoking gain-framed behaviours are the most persuasive
Charecteristics that determine message effectiveness at an individual level
- situations in which gain framed messaging may be more effective
- low involvement like nutrition information for gen pop
- the outcome is certain like belief that getting HIV vaccine though a trial would prevent contraction of HIV
- heurostic processing - promoting exercise to the gen pop
Situations in which loss framed may be more effective
- high involvement 0 brest cancer screening for high risk individuals
- outcome uncertain - crest self exams
- piecemeal processing - promoting healthy eating to registered dieticians
Womens health - adolesense
- early pubertal development affects your psycological well being enjoyment of PA and other indirect effects like lower PA as a result of that, the earlier you mature the more barriers there are
Menstrual cycle
- 2 main phases follicular and luteal
devided into menstration, follicular maturation, ovulation and the formation of teh corpus luteum - in research often described as subphases like earlu follicular ovulation early luteal mid luteal and late luteal
- during the menstrual cycle, you experience periods of low physical and psychological symptoms, including cramps, pain, low energy, low back pain, low motivation, etc
Psychological responses in the different phases of menstration
- during the follicular phase you have high psychological response ie good mood etc
- during the luteal phase, you have a bad psychological response, and low mood, especially during high-intensity PA, so moderate-intensity training is better than high-intensity training for this part of it
Physiological responses during mentral cycle
- no significnat different between mentral cycle phases ie liike o2 consumtpion which tells use that mentral phases affect mood rather than ability
- moderate intensity exercise during the luteal phase may help women maintain motivation and consistency
Pregnancy
- only 7 percent of preg women meet guidelines
Factors that are associated with this are - education - women with a degree were more likely to be active
- employment - being a paid employee was assocaited with higher activity levels
- BMI - lower BMI associated with higher activity levels
Helath beenfits of PA during pregnancy
- reduces risk of gestational diabteets hypertension preclampsia depression and anxity
- associated with better childbirth outocomes duch as shorter labor and recudes risk of incotinence post partum
Motherhood
- LTPA - associated wth lower levels of depressive symtoms in mothers of infants buffer on life stress on depression but does not buffer the influence of time pressure on depressive symtoms
- stress and time pressure
- mothers of infants experience bigh levels of stress and time pressure which can lead to depression
- life stress has a more substantial negative impact on depressive symptoms than time pressure
Menopause
- mark end of menstral cycle 12 months without a menstral period and occurs beterrn 45 and 55
- ovaries stop releasing eggs and slowed production of estrogen and progesteroen
Symtoms - hot flashes
night sweats
sleep disturbances
mood swings
vaginal dryness
Physical activity in menopause
- HIgher PA better mental health and lower psychological distress in women with menopause symtoms
- very active women report less depression compared to inactive women and less anxiety
Menopause and self perceived health
- very active women have higher prevalance of positive self perceived health compared to inactive
- higher pa and social suprt are preductors of better self perceived health and higher self esteem
Physical activity - women
- in all stages of life wmne are less active than men
- only 52 percent of girls are meeting the moderate to vigourous PA guidelines
- PA education iwthin schools is a key opportunity to physical activity however many girls report feeling unsupported in this envirment
Recommendations for PA in women
- creation of prorgams aimed at incresing PA amoung adolescnet girls should address the self consciousness and body disatisfaction that early maturing gurlks expeirence
- creation of exercise groups for women in a specific stage of life for that social supprt ie group of new moms that walk run or work out togetehr
Chronic conditions
- last more than 3 months
- prolonged do not resolve spontaneously and are rarely cured completly
- 45 percent of canadians live with at least one major chronic disease
- cost 122 billion annually
more women live it then men - the lower the household income the greater the prevalance
- as the population ages incresing nuber of people will live with at least one chornic condiition and will require care
- 1 in 12 has multimorbidity defined as having at least 3 or more chronic conditions at once
What are the most common chornic conditions
- hypertension 25 percent
osteoarthristis 14 percent
mood and axiety disorders at 13 percent
osteoporosis 12 and diabetes at 11 percent
Chornic conditions - what are some things its affected by
- Gender roles affect the illness experience - women report higher rates of distress than men whether they are the patient or the caregiver
- Social support affects disease outcomes for the better - support networks can encourage positive health behaviours reduce physiological reactivity to stress and lead to more adaptive coping
- The coping strategies an individual uses will likely avry with the ups and downs of disease - approach oriented coping strategies ie information seeking problem solveing seeking social support and avoidance oriented coping strategies ie denial and suppression, disengagement can be useful at differnt times approach oriented has been shown as a better long term but both have uses
- optimism is a key adaptive personality trait - acts as a buffer towards stressors by bolstering the use of approach-oriented coping strategies and reducing threat appraisals and avoidant coping
What are we aiming for when managign chornic conditions
- decrese of symtoms
- mastery of disease related adaptive tasks
- preservation of functional status
- perceived QOL in several domains
- absense of psychological disorders
- low neg and high pos afects
- maintaining purpose in life
Managing chornnic conditions 3 things
- Chronic disease required baalnced adjustment across multiple life domains - including interpersonal, cognitive, emotional, physical and behaviora domains - unbalanced attention towards positive adjustment can elad to negative consequences
- Adjustment is dynamic and unfolds over time - disease recurrance, flares, rapid improvements or declines are the realities of chornic disease
- Adjustments look different for different people - chronic disease often looks like islands of disruptions over time that are unique to an individual at different points in their lives
Chonic disease model - dont needa draw know takeaway
- Not a linear process - recirprocal cycle past experiences shape future outcomes rinse and repeat over time
- Internal and external factors shape how individuals engage with disease prevention and managemnt
- outcome expectations and self efficacy - play major roles in whetehr someone sticks with program
- self regulation - ongoing processes constantly assessing conditions making adjustments and refineing approach as they deal with day to day chronic disease
Efficacy and effectiveness of interventions - non surgical interventions
- for people with certain chronic conditions interventions focused on changing exercise diet and health behavior often lead to imprved functions
- additionally, chronic health interventions that also include psychosocial components ie health education counselling, and cognitive behavioural stress management are more effective than programs that dont
Adhereance to interventions
- This essentially is saying drop out is a hib hinderance to outcomes as there is no way to tell if someone will adhere so assume everyone will need some help
- adhereance supports include behavioral contingency contracting skills training like self monitoring tools, reminders, self efficacy enhancemnt etc
- major benefits in improving adherence in both individual and group formats as you need to tailor to individual needs
Working with inidviudals with chronic disease
- how to interact to achive outcomes
- Tailor programs on a person by person basis
- prioritise building rapport and partnership with the individual
- relay pertinent information so that the individual can understand and follow expert recommendations
Sleep and health - graphs
- over the last 20 years amount of sleep we have gotten has decresed
- U shaped curve on the perfect amount of sleep
- sweet spot of 6-8 hrs but best spot was 7.7 hrs anything above or below 6-8 is when incresed mortality hypertension and increses in BMI starts to form
1 in 3 adults get less than 7 - inadequete leads to development of chornic disease
Sleep what is it
- recurring reversible neurobehavioral state of relative perceptual disengagemtn and enresponsiveness to the enviroment - accompanied by postural recommence behaviousal quiescence and closed eyes
- ## sleep and wakefullness are natural recurring behavioral states that reflect cooridnated changes in the dynamic functional organization of the brain and that optimizes physiology behaviour and health
Sleep - homeostatic and circadian
- homeostatic and circadian processes regulate the propensity for wakefullness and sleep
- homeostatic pressure to sleep increses as a person stays awake
- circadian process is internal clock that runs on a 24 hour cycle even with no clock or windows will operate in the same way
Phases of sleep - NREM
- charecterised by progressively more synchonous cortical neruon activity, stable autonomic function and incresing arousal thresholds
-NREM is divided into 3 stages N123 N3 known as deep sleep brian becomes more cooridnated with itself and neurons begin to fire in a more coordinated way - also the most restorative phase of sleep
marked by - reductions in sympathetic activity, Lower HR and bp, more stable breathing patterns
Supports - Physical recovery, immune function and memory consolidation
Without it - Difficulty with physical exhaustion, poor immune function and difficulty retaining factual information
Phases of sleep - REM
- charecterised by brianwave activity that mimics relaxed wakefulness periodic bursts of rapid eye movement, variabel autonomic activity meaning that heart rate and breathing can fluctuate vs in NREM where is is slowed, and atonia of skeletal muscles which is skeletal muscle paralysis and is what prevents us from acting on our dreams as mind is active
Important for - cognitive function , emotional regulation, learning when we remove chance to get REM sleep it is hard to learn
- WIthout it Struggle with emotional regulation, things that take a lot of energy from frontal brain like creativuty and learning from experience
Sleep cycles
- Typicaly night sleep involved 4-6 repeated cycles of NREM and REM sleep each lasting 90-110 but stick to 90
- in the first half of the night NREM sleep dominates especially deep sleep
- in the second half of the night REM sleep periods get longer - most REM occurs in the early morning hours its why if you have to wake up early you feel sluggish as you havent given opportunity to get enough REM cycles in
- each serve a unique biological function
- the amount of cycles that are optimal for any individual is predicated on genetic markers and general wear and tear from the day
Sleep - Stats - men vs women
- women are disproportionally affected by sleep disturbances and daytime tiredness
- depending on age Women are more likely to expeirnce sleep disturbance compared to men and also more likleu to expierience daytime tiredness compared to men
- these imbalanced effects are exacerbated by additional sleep disturbances that occur during pregancy motherhood and menopause
- MEn disproportionally expierence some sleep disturbances too includeing obstructive sleep apnea, REM behavior disorder which means they act out dreams from a lack of paralysis think sleep walking, and a steeper decline in slow wave sleep generation as they age meaning less deep and restorative sleep
Sleep - stat - Other racial and ethnic groups
- black are more likley to exiperence very short slepe duration whihc is charecterised as sleep less than 4 hours compared to white and asians are more then black and white to expiernce it
- this may be due to exposure to racial discrimination that has been found to be associated with sleep disturbances
Sleep health
- a multidimensional pattern of sleep - wakefulness adapted to individual social and enviromental demands that promotes physical and mental well being
- Good sleep health is charecterised by subjective satisfaction, approproiate timing, adequate duration, high efficiency and sustained alertness during waking hours
- poor slepe is largely accounted for by the high prevalnce of primary sleep disorders ie sleep ap insomnia etc and the growing number of people living with chornic sleep deficince which is a state of inadequate or mistimed sleep independant of a sleep disorder
- Again its not just the absense of a sleep disorder in itself that classifies sleep health but overall wellbeing
Dimensions of sleep health SATED
- Satisfaction and quality - ones subjective assessment of good or poor sleep - ie consistently wakes up groggy despite getting enough sleep
- Alertness/sleepiness/napping - ability to maintain adequate wakefulness- someone that struggles to stay awake or while driving etc may have por daytime alertness
-timing - the placement of sleep witihn 24 hours - regulation of slepe in relation to biological rythms - someone that sleeps between hrs of 3 am to 11 may expeerince misalignemnt with work or social situations leading to difficulty vs 11 am to 7 am - score higher on this domain
-Efficiency - the ease of falling asleep and returning to sleep - take a long time to fall asleep lower score
-Duration - the amount of sleep obtained in 24 hrs - 7-8 hrs is recommended
Other dimensions of sleep health
- soundness - the depth of ones neurological rest - ie difficult to measure lab based recording
- regularity - how often an individual is reaching their desired quantity and quality of sleep
- adaptability - whether an individual can adjust after an irregular sleep period or during times of stress ability to function despite irregular sleep or disruptions
Sleep health - how can it be imroved - individual factors
- maintain regular bedtime and wake
- limit caffeince alcohol substance use - prevents REM sleep
- Create a cool dark and quiet room ‘
- restrict digital media 60 mins before
Sleep health - how can it be inmproved - sociodemographic factors
- be aware that stress caused by challenges encountered by disadvantaged groups particularly those who expiereucne financial insecuity, saftey concersn and limited autonomy over their life chocices, has a significant and negative effect on sleep
Sleep health - how can it be improved - interpersonal factors
- introduction of family and group based interventions may be an effective streategy to help all members of a household, recognize that their behaviors may contribute to the sleep patterns of others
sleep health - how can it be improved - community factors
- interventiosn at the community level include opportunities to adjust workplace enviroments school start times health care systems and features of the built and social enviroents to improve sleep health
Sleep helath - ow can it be improved - societal factors
implement cultural leadership (public health priorities and slepe health awareness campaigns) and public policy including regulations and incentives (regulation of shift work elimination of daylight savings tax incentives for corporate wellness programs etc
